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Nicu Brodsky+Pediatrix+NeoReview Questions > MFM > Flashcards

MFM Flashcards

1
Q

Side effects of indomethacin?

A

pulmonary hypertension, renal insufficiency, ileal perforation, or NEC

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2
Q

Does transient neonatal MG correlate with severity of maternal dz or level of mom’s titers?

A

no!

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3
Q

Is NAS severity withdrawal related to amount of opiate exposure?

A

no!

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4
Q

What additional drug can be used to treat NAS especially if additional cNS sx or if mom had poly-substance use

A

phenobarbital

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5
Q

symptoms of fetal alcohol syndrome

A

SHORT palpebral fissures, thin vermilion border, smooth philtrum. Can also cause cardiac (VSD, TOF+PS), CNS abnormalities

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6
Q

Incidence of choroid plexus cysts?

A

<1% of infants

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7
Q

What medications for GDM cannot be used in pregnancy bc they cross placenta?

A

metformin and glyburide

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8
Q

Maternal ITP, mom’s platelets are _____, most neonates are affected/unaffected. In Gestational thrombocytopenia, maternal Plt are _____ and most neonates are unaffected/affected

A

Maternal ITP: mom’s platelets < 70k, most neonates unaffected
Gestational: mom’s platelets > 70k, most neonates unaffected

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9
Q

Pregnant women with mumps or measles are at higher risk of spontaneous abortion?

A

mumps

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10
Q

What is the dominant thyroid hormone in fetal life?

A

RT3

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11
Q

In PKU, what improves fetal outcomes?

A

Low maternal phenylalanine concentrations BEFORE conception

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12
Q

2 vessel cord associations

A

cardiac and renal anomalies, IUGR, preterm birth. NO fetal demise

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13
Q

Quad screen for T21

A

Low / high / low / high
AFP / beta HCG, uE3, inhibit A

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14
Q

What is category III tracing?

A

absent FHR variability AND recurrent lates, recurrent variables, bradycardia, sinusoidal

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15
Q

Fetal alcohol syndrome leads to (growth and development wise)

A

persistent microcephaly, prenatal/postnatal growth restriction, MR

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16
Q

What is the most accurate measurement to predict fetal GA

A

fetal crown rump length measured b/w 7-10 weeks gestation

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17
Q

Amniocentesis performed early has increased risk of ______

A

talipes equinovarus (club foot)

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18
Q

Fetal weight is estimated from ______

A

abdominal girth, biparietal diameter, head circumference, femur length

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19
Q

Placentas of fetuses that exhibit abnormal doppler flow velocity ______

A

slender capillaries with decreased capillary loops in gas-exchanging terminal villi

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20
Q

What are components of biophysical profile?

A

5 categories, score of 2 or 0
NST: 2 accels within 20 mins associated with fetal movements
Fetal body movement: assess for at least 3 fetal movements in 30 min period
Breathing: assess for 30 seconds of continuous breathing during 30 min period
Tone: one extension/flexion cycle of a limb with rapid return to flexed position during 30 min period
Amniotic fluid volume: presence of single pocket > 2 cm

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21
Q

Interpretation of BPP score

A

10 - well fetus
8 w/ normal AFV: well fetus
8 with decreased AFV: some kind of asphyxia, deliver or recheck soon
6: labor induction if >36 weeks if favorable cervix and normal AFI. Repeat testing in 24 hrs if <36 weeks and cervix unfavorable. Deliver if <6.
4: labor induction if GA>32 weeks. Repeat same day if <32 weeks, deliver is <6
<2: labor induction

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22
Q

What happens when people PPROM between 28-34 weeks?

A

50% will progress to labor in 24 hrs and 80-90% will progress to labor within 1 week. Try to make it to 34 weeks

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23
Q

Amino acids require active / passive transport against concentration gradient (placenta)

A

active transport

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24
Q

Antiphospholipid syndrome

A

autoimmune disease associated with recurrent pregnancy loss, thrombophilia, fetal growth impairment, placental insufficiency, pre-E, and preterm birth.

10-48% of patients with APS also have pre-E. Heparin improves live birth rates but does NOT improve obstetric complications

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25
Q

Disorders that cause oligohydramnios

A

fetal urinary tract anomalies, placental insufficiency, premature ROM, TTTS, maternal meds (indomethacin, ACE-inhibitors)

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26
Q

Polyhydramnios associated conditions

A

T18, T21, Turner, Beckwith Wiedemann

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27
Q

T18 quad screen

A

low / low / low / normal
AFP / beta / estriol / inhibit A

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28
Q

T13 quad screen

A

trick question - quad screen not helpful

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29
Q

What is low ponderal index signify?

A

asymmetric growth
Ponderal index = weight (g) x 100 / (crown - heel)^3

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30
Q

What happens to CBC, coags in pregnant women?

A

Increase in coagulation factors. Unchanged platelets, WBC increased, dilution anemia.

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31
Q

Is there increased maternal infection risk for twins?

A

no!

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32
Q

Teratogenic effects of maternal ACE inhibitor use

A

renal tubular dysgenesis, hypoplasia of skull, fetal compression syndrome with limb deformities, pulmonary hypoplasia in setting of oligohydramnios

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33
Q

Fetal effects of PHB, hydantoin, warfarin

A

PHB - fetal cleft lip/palate, cardiac abnormalities, GU anomalies
Hydantoin - digit and nail hypoplasia, IUGR
Warfarin - nasal hypoplasia and stippled bone epiphysis

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34
Q

Amnion nodosum

A

lesion of fetal membranes and placenta seen in pregnancies complicated by severe and long-standing oligo. PPROM, TTTS, severe IDM with placental vascular disease can cause

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35
Q

Larger twin in mono-chorionic pregnancies is at risk for ______

A

HOCM and neuro injury

36
Q

Vanishing twin syndrome sequelae

A

higher incidence of preterm birth, lower BW, higher risk of double death, some evidence that Neuro developmental outcomes for surviving twin are most likely to be normal

37
Q

Placenta produces large # of hormones. What layer and what hormones?

A

Syncytiotrophoblast - outer layer of blastcocyst.
Produces HcG, human placental lactogen, leptin, progesterone, estrogens, insulin growth factor (but NOT insulin)

38
Q

Maternal macronutrient deficiency increases risk for ______

A

T2DM, cardiovascular disease, HTN, dyslipidemia later in life

39
Q

How does obesity affect gastroschisis frequency?

A

Obesity DECREASES incidence in gastroschisis

40
Q

Oral glucocorticoids in pregnancy affects babies

A

higher rate of preterm birth and low BW

41
Q

Side effects of maternal valproate use

A

NTD, cleft palate, hypospadias, craniosynostosis, polydactyly

42
Q

Marfan syndrome on babies

A

highest risk for preterm delivery, cervical incompetence, premature ROM

43
Q

What electrolyte reduces maternal blood lead levels

A

calcium

44
Q

Side effects of epidural anesthesia?

A

maternal hypotension, fever, longer second stage of labor

45
Q

What maternal condition causes 15-25% cases of polyhydramnios

A

maternal DM
Fetal hyperglycemia –> increased osmotic diuresis –> fetal polyuria
Therapeutic tx with indomethacin

46
Q

What is next step for decreased fetal movements?

A

biophysical profile

47
Q

IUFD in monochorionic twins –>what sequelae in surviving twin

A

multi cystic encephalomalacia and multiorgan damage in surviving twin (acute feto-fetal transfusion at time of demise, rapid blood loss from surviving twin to demised twin)

48
Q

Management of IUFD in monochorionic twins in >24 and <24 weeks

A

> 24 weeks: counseled about multi cystic encephalomalacia, no interventions available
second trimester single IUFD before viability –> termination can be discussed

49
Q

Gas exchange at placenta occurs at the ______

A

microvillus surface

50
Q

What does sinusoidal tracing typically entail

A

severe anemia

51
Q

Late preterm have higher risk of ____

A

congenital malformations. However less likely to have IUGR compared to term infants

52
Q

Biggest sequelae of maternal chorio?

A

endometritis (30%)

53
Q

Subnecrotizing funisits or chronic chorio = increased risk for ______ (in baby)

A

chronic lung disease

54
Q

Leading risk factor for shoulder dystocia?

A

maternal DM

55
Q

Risk for external cephalic version?

A

transplacental hemorrhage

56
Q

What decreases risk of uterine rupture for TOLAC?

A

delivery following spontaneous labor

57
Q

What to do if NST is bad?

A

BPP or contraction stress test

58
Q

Next step if polyhydramnios? What AFI level?

A

AFI > 25. test for diabetes

59
Q

Where is sugaleal bleed located?

A

below aponeurosis and above periosteum

60
Q

In the placenta - maternal vs fetal blood

A

maternal blood bathes fetal vessels and gives up O2 to fetal blood

61
Q

Transport across placenta favors lipids or water?

A

trophoblastic tissue favors lipid soluble

62
Q

Placenta characteristics throughout pregnancy (thickness / microvilli)

A

thinner (10 –> 1.7 micro meters) and more villi (600–>1200 10^6) –> allows for better diffusion

63
Q

How are carbs and amino acids transferred across placenta? NaCl?

A

Amino Acid - active transport
Carbs - facilitated diffusion (GLUT receptors across concentration gradient)
lipid transport mostly unknown, but probably transplacental

NaCl - simple diffusion (Salt is simple)
K regulated, Ca active transpo

64
Q

Vasia previa is most likely to happen with

A

velamentous insertion

65
Q

Different types of placenta previa

A

low lying: edge 0-2 cm from cervix
Previa: edge overlapping 3.2 cm cervix
complete - equal parts overlapping

66
Q

when to deliver placenta accreta

A

34-36 weeks

67
Q

what is circumvallate placenta

A

small chorionic plate with growth of extrachorial tissue - usually does not compromise fetomaternal exchange

68
Q

velamentous cord insertion

A

normal pregnancies, the umbilical cord inserts into the middle of the placental mass and is completely encased by the amniotic sac. The vessels are hence normally protected by Wharton’s jelly, which prevents rupture during pregnancy and labor. In velamentous cord insertion, the vessels of the umbilical cord are improperly inserted in the chorioamniotic membrane, and hence the vessels traverse between the amnion and the chorion towards the placenta.Without Wharton’s jelly protecting the vessels, the exposed vessels are susceptible to compression and rupture

69
Q

medically managed hypothyroidism in mother leads to _____. What to treat with?

A

euthyroid newborn that becomes hyperthyroid in first week

must observe mother until PTU has metabolized (several days to 1 week)

PTU first trimester (liver toxicity)
MMI thereafter (facial, EA, aplasia cutis, choanal atresia)

70
Q

Timing of twin gestation formation

A

Cleavage 1-3 days: Di/Di (morula)
4-8 days: Mono/di (blastocyst)
8-12 days: Mono/mono (implanted blastocyst)
13-15 days: conjoined (embryonic disc)

71
Q

When to deliver mono-mono twins

A

32-34 weeks

72
Q

etiologies for non-immune hydrops

A

Anemia (ex: parvovirus, feto-maternal hemorrhage, twin-to-twin transfusion)
Cardiac Failure (ex: elevated RA pressure such as tricuspid atresia, heart block, tachyarrhythmia)
Decrease osmotic pressure (ex: syphilis)
Impaired lymphatic drainage (cystic hygroma, chromosomal abnormalities)

73
Q
A
74
Q

DDx of Very Low or Undectectable Maternal Serum Estriol Level

A

Placental sulfatase deficiency
– Anencephaly
– CAH
–Molar pregnancy

75
Q

what hormone does hcg mimic?

A

TSH (same alpha subunit)

76
Q

How to screen for aneuploidy in 1st trimester?

A

GA 11-13 weeks
Age plus NT plus serum markers
– Pregnancy-associated plasma protein-A (PAPP-A)
– Beta-hCG

77
Q

How to screen for aneuploidy in 2nd trimester?

A
  • 15-20 weeks; “quadruple screen”
  • Age plus serum markers
    – Alpha fetoprotein (AFP)
    – Human chorionic gonadotropin (hCG) – Unconjugated estriol (UE3)
    – Inhibin-A
78
Q

When can you do cell-free DNA?

A

after 10 weeks
Fetal DNA in maternal serum

79
Q

what type of placenta can identical (monozygotic twins have)

A

all of the above

Dizygotic is ALWAYS di/di

80
Q

Describe FHR

A
  • Category I
    – Baseline 110-160
    – Moderate variability
    – No late or variable decelerations
  • Category III
    – Absent variability and any of:
  • Recurrent late or variable decelerations * Bradycardia

Cat II is everything else

81
Q

What Is a reactive NST

A

2 or more accels in a 20 min window

82
Q

describe a BPP (performed over 30 mins)

A

0 or 2 points
NST reactive
Breathing >= 30 seconds
Movement >= 3 torso/limbs
Tone >= 1 flex/extend
Fluid >=2 cm

8 or 10 is good

83
Q

teratogenic effects of warfarin and phenytoin

A

microcephaly, midface hypoplasia

84
Q

Categories of drug labeling (2015)

A

Pregnancy, lactation, females + males of reproductive potential

85
Q

What US findings concerning for CMV

A

FGR, VM, echogenic bowel, hepatic/intracranial calcifications, hydrops

Nicu Brodsky+Pediatrix+NeoReview Questions (14 decks)

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